Outcome analysis of end‐stage renal failure patient on hemodialysis and peritoneal dialysis underwent parathyroidectomy for secondary hyperparathyroidism

Abstract

Aim: The outcome between end‐stage renal failure patients on hemodialysis and peritoneal dialysis who underwent parathyroidectomy was studied.

Methods: Patients underwent parathyroidectomy from Jan 2008 to Dec 2015 for secondary renal hyperparathyroidism in Queen Mary Hospital were reviewed for short‐term and long‐term outcomes. Persistent disease is defined as elevation of PTH >800 pg/ml within 6 months after operation; whereas recurrence is defined as elevation of PTH >800 pg/ml after 6 months.

Results: There were total 97 patients underwent parathyroidectomy (HD vs PD; 29 vs 68). The average time of follow‐up was 46 month. The rate of hungry bone syndrome were 27.6% in HD group and 23.9% in PD group (p = 0.798). The overall permanent recurrent laryngeal nerve palsy rate was 2.1% (HD vs PD, 0% vs 2.9%, p=1.0).

5 patients had persistent disease (HD 3/29 vs PD 2/68, p=0.156) and 10 patients had recurrence (HD 2/29 vs PD 8/68, p= 0.718). The overall persistent and recurrence rate was 5.1% and 11.1% respectively. The median time to recurrence is 33.5 months. Intraoperative identification of less than 4 parathyroid glands was associated with persistent disease (p=0.01) but not recurrent disease (p=0.599).

Conclusion: The short‐term and long‐term outcomes between the two groups of patients are similar. Intraoperative identification of all 4 parathyroid glands is essential for lowering the risk of persistent disease.